Absolute benefit of adjuvant endocrine therapies for premenopausal women with hormone receptor-positive, Human epidermal growth factor receptor 2-Negative early breast cancer: TEXT and SOFT Trials

Meredith M. Regan, Prudence A. Francis, Olivia Pagani, Gini F. Fleming, Barbara A. Walley, Giuseppe Viale, Marco Colleoni, István Láng, Henry L. Gómez, Carlo Tondini, Graziella Pinotti, Karen N. Price, Alan S. Coates, Aron Goldhirsch, Richard D. Gelber

Research output: Contribution to journalArticle

Abstract

Purpose Risk of recurrence is the primary consideration in breast cancer adjuvant therapy recommendations. The TEXT (Tamoxifen and Exemestane Trial) and SOFT (Suppression of Ovarian Function Trial) trials investigated adjuvant endocrine therapies for premenopausal women with hormone receptor-positive breast cancer, testing exemestane plus ovarian function suppression (OFS), tamoxifen plus OFS, and tamoxifen alone. We examined absolute treatment effect across a continuum of recurrence risk to individualize endocrine therapy decision making for premenopausal women with human epidermal growth factor receptor 2 (HER2) -negative disease. Patients and Methods The TEXT and SOFT hormone receptor-positive, HER2-negative analysis population included 4,891 women. The endpoint wasbreast cancer-free interval (BCFI), defined as time from random assignment to first occurrence of invasive locoregional, distant, or contralateral breast cancer. A continuous, composite measure of recurrence risk for each patient was determined from a Cox model incorporating age, nodal status, tumor size and grade, and estrogen receptor, progesterone receptor, and Ki-67 expression levels. Subpopulation treatment effect pattern plot methodology revealed differential treatment effects on 5-year BCFI according to composite risk. Results SOFT patients who remained premenopausal after chemotherapy experienced absolute improvement of 5% or more in 5-year BCFI with exemestane plus OFS versus tamoxifen plus OFS or tamoxifen alone, reaching 10% to 15% at intermediate to high composite risk; the benefit of tamoxifen plus OFS versus tamoxifen alone was apparent at the highest composite risk. The SOFT no-chemotherapy cohort-for whom composite risk was lowest on average-did well with all endocrine therapies. For TEXT patients, the benefit of exemestane plus OFS versus tamoxifen plus OFS in 5-year BCFI ranged from 5% to 15%; patients not receiving chemotherapy and with lowest composite risk did well with both treatments. Conclusion Premenopausal women with hormone receptor-positive, HER2-negative disease and high recurrence risk, as defined by clinicopathologic characteristics, may experience improvement of 10% to 15% in 5-year BCFI with exemestane plus OFS versus tamoxifen alone. An improvement of at least 5% may be achieved for women at intermediate risk, and improvement is minimal for those at lowest risk.

Original languageEnglish
Pages (from-to)2221-2230
Number of pages10
JournalJournal of Clinical Oncology
Volume34
Issue number19
DOIs
Publication statusPublished - Jul 1 2016

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exemestane
Tamoxifen
Hormones
Breast Neoplasms
Therapeutics
Recurrence
Drug Therapy
human ERBB2 protein

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Absolute benefit of adjuvant endocrine therapies for premenopausal women with hormone receptor-positive, Human epidermal growth factor receptor 2-Negative early breast cancer : TEXT and SOFT Trials. / Regan, Meredith M.; Francis, Prudence A.; Pagani, Olivia; Fleming, Gini F.; Walley, Barbara A.; Viale, Giuseppe; Colleoni, Marco; Láng, István; Gómez, Henry L.; Tondini, Carlo; Pinotti, Graziella; Price, Karen N.; Coates, Alan S.; Goldhirsch, Aron; Gelber, Richard D.

In: Journal of Clinical Oncology, Vol. 34, No. 19, 01.07.2016, p. 2221-2230.

Research output: Contribution to journalArticle

Regan, Meredith M. ; Francis, Prudence A. ; Pagani, Olivia ; Fleming, Gini F. ; Walley, Barbara A. ; Viale, Giuseppe ; Colleoni, Marco ; Láng, István ; Gómez, Henry L. ; Tondini, Carlo ; Pinotti, Graziella ; Price, Karen N. ; Coates, Alan S. ; Goldhirsch, Aron ; Gelber, Richard D. / Absolute benefit of adjuvant endocrine therapies for premenopausal women with hormone receptor-positive, Human epidermal growth factor receptor 2-Negative early breast cancer : TEXT and SOFT Trials. In: Journal of Clinical Oncology. 2016 ; Vol. 34, No. 19. pp. 2221-2230.
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abstract = "Purpose Risk of recurrence is the primary consideration in breast cancer adjuvant therapy recommendations. The TEXT (Tamoxifen and Exemestane Trial) and SOFT (Suppression of Ovarian Function Trial) trials investigated adjuvant endocrine therapies for premenopausal women with hormone receptor-positive breast cancer, testing exemestane plus ovarian function suppression (OFS), tamoxifen plus OFS, and tamoxifen alone. We examined absolute treatment effect across a continuum of recurrence risk to individualize endocrine therapy decision making for premenopausal women with human epidermal growth factor receptor 2 (HER2) -negative disease. Patients and Methods The TEXT and SOFT hormone receptor-positive, HER2-negative analysis population included 4,891 women. The endpoint wasbreast cancer-free interval (BCFI), defined as time from random assignment to first occurrence of invasive locoregional, distant, or contralateral breast cancer. A continuous, composite measure of recurrence risk for each patient was determined from a Cox model incorporating age, nodal status, tumor size and grade, and estrogen receptor, progesterone receptor, and Ki-67 expression levels. Subpopulation treatment effect pattern plot methodology revealed differential treatment effects on 5-year BCFI according to composite risk. Results SOFT patients who remained premenopausal after chemotherapy experienced absolute improvement of 5{\%} or more in 5-year BCFI with exemestane plus OFS versus tamoxifen plus OFS or tamoxifen alone, reaching 10{\%} to 15{\%} at intermediate to high composite risk; the benefit of tamoxifen plus OFS versus tamoxifen alone was apparent at the highest composite risk. The SOFT no-chemotherapy cohort-for whom composite risk was lowest on average-did well with all endocrine therapies. For TEXT patients, the benefit of exemestane plus OFS versus tamoxifen plus OFS in 5-year BCFI ranged from 5{\%} to 15{\%}; patients not receiving chemotherapy and with lowest composite risk did well with both treatments. Conclusion Premenopausal women with hormone receptor-positive, HER2-negative disease and high recurrence risk, as defined by clinicopathologic characteristics, may experience improvement of 10{\%} to 15{\%} in 5-year BCFI with exemestane plus OFS versus tamoxifen alone. An improvement of at least 5{\%} may be achieved for women at intermediate risk, and improvement is minimal for those at lowest risk.",
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T1 - Absolute benefit of adjuvant endocrine therapies for premenopausal women with hormone receptor-positive, Human epidermal growth factor receptor 2-Negative early breast cancer

T2 - TEXT and SOFT Trials

AU - Regan, Meredith M.

AU - Francis, Prudence A.

AU - Pagani, Olivia

AU - Fleming, Gini F.

AU - Walley, Barbara A.

AU - Viale, Giuseppe

AU - Colleoni, Marco

AU - Láng, István

AU - Gómez, Henry L.

AU - Tondini, Carlo

AU - Pinotti, Graziella

AU - Price, Karen N.

AU - Coates, Alan S.

AU - Goldhirsch, Aron

AU - Gelber, Richard D.

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Purpose Risk of recurrence is the primary consideration in breast cancer adjuvant therapy recommendations. The TEXT (Tamoxifen and Exemestane Trial) and SOFT (Suppression of Ovarian Function Trial) trials investigated adjuvant endocrine therapies for premenopausal women with hormone receptor-positive breast cancer, testing exemestane plus ovarian function suppression (OFS), tamoxifen plus OFS, and tamoxifen alone. We examined absolute treatment effect across a continuum of recurrence risk to individualize endocrine therapy decision making for premenopausal women with human epidermal growth factor receptor 2 (HER2) -negative disease. Patients and Methods The TEXT and SOFT hormone receptor-positive, HER2-negative analysis population included 4,891 women. The endpoint wasbreast cancer-free interval (BCFI), defined as time from random assignment to first occurrence of invasive locoregional, distant, or contralateral breast cancer. A continuous, composite measure of recurrence risk for each patient was determined from a Cox model incorporating age, nodal status, tumor size and grade, and estrogen receptor, progesterone receptor, and Ki-67 expression levels. Subpopulation treatment effect pattern plot methodology revealed differential treatment effects on 5-year BCFI according to composite risk. Results SOFT patients who remained premenopausal after chemotherapy experienced absolute improvement of 5% or more in 5-year BCFI with exemestane plus OFS versus tamoxifen plus OFS or tamoxifen alone, reaching 10% to 15% at intermediate to high composite risk; the benefit of tamoxifen plus OFS versus tamoxifen alone was apparent at the highest composite risk. The SOFT no-chemotherapy cohort-for whom composite risk was lowest on average-did well with all endocrine therapies. For TEXT patients, the benefit of exemestane plus OFS versus tamoxifen plus OFS in 5-year BCFI ranged from 5% to 15%; patients not receiving chemotherapy and with lowest composite risk did well with both treatments. Conclusion Premenopausal women with hormone receptor-positive, HER2-negative disease and high recurrence risk, as defined by clinicopathologic characteristics, may experience improvement of 10% to 15% in 5-year BCFI with exemestane plus OFS versus tamoxifen alone. An improvement of at least 5% may be achieved for women at intermediate risk, and improvement is minimal for those at lowest risk.

AB - Purpose Risk of recurrence is the primary consideration in breast cancer adjuvant therapy recommendations. The TEXT (Tamoxifen and Exemestane Trial) and SOFT (Suppression of Ovarian Function Trial) trials investigated adjuvant endocrine therapies for premenopausal women with hormone receptor-positive breast cancer, testing exemestane plus ovarian function suppression (OFS), tamoxifen plus OFS, and tamoxifen alone. We examined absolute treatment effect across a continuum of recurrence risk to individualize endocrine therapy decision making for premenopausal women with human epidermal growth factor receptor 2 (HER2) -negative disease. Patients and Methods The TEXT and SOFT hormone receptor-positive, HER2-negative analysis population included 4,891 women. The endpoint wasbreast cancer-free interval (BCFI), defined as time from random assignment to first occurrence of invasive locoregional, distant, or contralateral breast cancer. A continuous, composite measure of recurrence risk for each patient was determined from a Cox model incorporating age, nodal status, tumor size and grade, and estrogen receptor, progesterone receptor, and Ki-67 expression levels. Subpopulation treatment effect pattern plot methodology revealed differential treatment effects on 5-year BCFI according to composite risk. Results SOFT patients who remained premenopausal after chemotherapy experienced absolute improvement of 5% or more in 5-year BCFI with exemestane plus OFS versus tamoxifen plus OFS or tamoxifen alone, reaching 10% to 15% at intermediate to high composite risk; the benefit of tamoxifen plus OFS versus tamoxifen alone was apparent at the highest composite risk. The SOFT no-chemotherapy cohort-for whom composite risk was lowest on average-did well with all endocrine therapies. For TEXT patients, the benefit of exemestane plus OFS versus tamoxifen plus OFS in 5-year BCFI ranged from 5% to 15%; patients not receiving chemotherapy and with lowest composite risk did well with both treatments. Conclusion Premenopausal women with hormone receptor-positive, HER2-negative disease and high recurrence risk, as defined by clinicopathologic characteristics, may experience improvement of 10% to 15% in 5-year BCFI with exemestane plus OFS versus tamoxifen alone. An improvement of at least 5% may be achieved for women at intermediate risk, and improvement is minimal for those at lowest risk.

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